SEXUAL PROBLEMS IN WOMEN: PAIN ON INTERCOURSE

In the majority of cases the cause of the pain is physical. A woman may have pain or discomfort if she has a vaginal discharge; immediately after having a baby; for weeks or months after an episiotomy; for some weeks after a vaginal operation; as a result of internal disorders of her reproductive organs; if intercourse is attempted too quickly, before she is lubricating; after the menopause if there is dryness of the vagina; and for a host of other reasons. Any persistent pain for which there is no obvious cause should be reported to a doctor. If when intercourse is attempted the muscles surrounding the vaginal entrance go into an involuntary spasm, this is called vaginismus. Some women also suffer from vaginismus because, for example, they do not ‘accept’ their vagina, are guilty about sex, are anxious early on in a sexual relationship or fear the penis or getting pregnant. Latent or actual lesbians may suffer from the same problem when heterosexual intercourse is attempted. Other women experience vaginismus for some time after being raped or after similarly distressing sexual experiences.

Treatment, which can be very difficult and may involve psychosexual therapy, consists of persuading the woman to accept vaginal penetration by, for example, fingers at first and then, perhaps, objects of increasing size or a vibrator. When eventually penile penetration is attempted some woman fare best if they control it by being on top of the man whereas others function best underneath or on all fours. If the vagina is well lubricated and the penis inserted slowly and gently, pausing for a moment if any painful spasm results, full penetration can usually be achieved. One technique which sometimes works well when all else fails is to instruct the woman in the voluntary control of her vaginal muscles. When penetration is attempted she contracts them as firmly as she can momentarily, whilst her man pauses. As she relaxes the man pushes his penis in a little further and so on.

Sex problems vary from a total lack of interest in sex to its inefficient or unenjoyable expression. The inefficiency may only amount to a slight brake on pleasure but in the end the person’s interest usually remains fixed on intercourse. Sex is more in the mind than their genitals but the central problem is one of genital inefficiency. Some can overcome their problem and function well if certain conditions, or partners, are available.

For some unfortunate people their desires never exceed the fears and they never function well, or even at all, with another human being, either heterosexually or homosexually. Sometimes the cause is no more than a belief, in a shy and inhibited person, that there is something unacceptably wrong with their body, such as a small penis or different-sized breasts. In some, the feared defect is not even really there, or it is trivial and is simply being used to mask a deeper fear.

Fortunately, more help is available today than ever before and a person with a sex problem can usually find some answers, if not necessarily a complete cure, at a special centre.

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